Outcomes and Predictors of Mortality and Stoma Formation in Surgical Management of Colonoscopic Perforations

Teoh, Anthony Y.; Poon, Chi‐Ming; Lee, Janet Fung Yee; Leong, Hing Tat; Ng, Simon Siu Man; Sung, Joseph J.Y.; Lau, James Y.

doi:10.1001/archsurg.2008.503

Cited by 61 publications

(69 citation statements)

References 29 publications

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“…Large series of colonoscopy induced perforations managed surgically reported a morbidity rate of 35% [4,7]. The mortality rate in our study is fairly comparable to other reports which is up to 25% [7,8]. Surgical site infection is the most common complication, while cardiopulmonary complications and multiple organ failure are the leading causes of death [7,24].…”

Section: Discussionsupporting

confidence: 81%

“…Our study demonstrated the same results, but we didn't find statistical significant relationship between time to surgery and postoperative complications. Several other factors are also known to influence outcome, namely, advanced age of patients, severe comorbidities, a large perforation site, poor bowel preparation, corticosteroid use, anticoagulant or antiplatelet therapy [7,8,25].…”

Section: Discussionmentioning

confidence: 99%

“…Interventions performed during colonoscopy, such as biopsy, polypectomy, and endoscopic submucosal dissection may increase the rate of iatrogenic colonic perforation [6]. Although those complications are rare, but they can lead to leakage of bowel content into the peritoneal cavity and eventually to sepsis, with significant morbidity (up to 40%) and mortality (up to 25%) [4,7,8]. The site of colon perforation must be closed immediately to prevent complications.…”

Section: Introductionmentioning

confidence: 99%

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Jatrogeninė kolonoskopinė storosios žarnos perforacija: vieno centro chirurginio gydymo rezultatai

Smolskas¹,

Dulskas²,

Kildusiene³

et al. 2017

LietChirur

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BackgroundAlthough the incidence of iatrogenic colonoscopic perforation is low, it can result in severe complications and mortality. This study assessed the incidence and surgical management outcomes of iatrogenic colonic perforations. Materials and MethodsWe reviewed all the medical records of patients with colonic perforations during diagnostic or therapeutic colonoscopies from January 2007 to December 2016 at National Cancer Institute. We collected the patient's demographic data, colonoscopic reports, and data regarding the location of perforations, their treatment and outcome. Results 16 186 colonoscopies were performed at National Cancer Institute. The overall perforation rate was 0.14% (23 of 16 186). Of the total 23 colon perforations, 20 were managed operatively. The most common location was the sigmoid colon, in 12 cases. The most used surgical technique was simple suture (11 cases) followed by resection with anastomosis (6 cases). Three patients died (one because of multiple organ failure caused by acute bronchopneumonia and two patients with intraabdominal sepsis died due cardiopulmonary insufficiency). Conclusions: If surgery and its associated morbidity can be avoided in cases of colonic perforation the negative impact of a colonoscopy-associated complication can be minimized considerably. Patients need to be informed of the complications of colonoscopy, and clinicians must be cautioned about the potential problems for patients with a high anaesthetic risk when performing the procedure. Key words: colonoscopy, colonic perforation, peritonitis, Iatrogenic injury 109Iatrogenic colonic perforation by colonoscopy: outcomes of surgery at a single center ĮvadasNors kolonoskopinių gaubtinės žarnos perforacijų dažnis nėra didelis, tačiau jos gali lemti sunkias komplikacijas ar net mirtį. Šios studijos tikslas buvo įvertinti kolonoskopinių gaubtinės žarnos perforacijų dažnį ir jų chirurginio gydymo rezultatus. Metodai Retrospektyviai buvo peržiūrėti duomenys pacientų, kuriems atliekant diagnostinę ar gydomąją kolonoskopiją Nacionaliniame vėžio institute nuo 2007 m. sausio 1 d. iki 2016 m. gruodžio 31 d. įvyko gaubtinės žarnos perforacijos. Analizuoti pacientų demografiniai rodikliai, kolonoskopijos duomenys, informacija apie jų gydymą ir gydymo rezultatus. Rezultatai Iš viso Nacionaliniame vėžio institute minėtu laikotarpiu buvo atlikta 16 186 kolonoskopijos. Bendras kolonoskopinių gaubtinės žarnos perforacijų dažnis siekė 0,14 % (23 iš 16 186 pacientų). Iš šių 23 perforacijų 20 atvejų buvo taikytas chirurginis gydymas. Daugiausiai perforacijų įvyko riestinėje žarnoje (12 atvejų). 11 atvejų defektas žarnoje buvo užsiūtas, 6 atvejais atlikta žarnos rezekcija su pirmine anastomoze. Viena mirtis įvyko dėl ūmios bronchopneumonijos išsivysčius dauginiam organų disfunkcijos sindromui, kiti du pacientai, kuriems pasireiškė pilvo ertmės sepsis, mirė nuo kardiopulmoninio nepakankamumo. Išvados Jeigu kolonoskopinės gaubtinės žarnos perforacijos atvejais pavyktų išvengti operacijos ir ją lydinčių sunkių komplikacijų, t...

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Jatrogeninė kolonoskopinė storosios žarnos perforacija: vieno centro chirurginio gydymo rezultatai

Smolskas¹,

Dulskas²,

Kildusiene³

et al. 2017

LietChirur

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“…Perforations may be pneumatic due to excessive distension of the intestinal wall from high-pressure insufflations or mechanic from the pressure exerted by the gastroenterologist [3]. With regards to the time of diagnosis, perforations produced from diagnostic colonoscopy (due to the mechanical pressure) are larger and are detected promptly since patients are admitted earlier, while those occurring from therapeutic colonoscopy are diagnosed late and are smaller in size [4]. Sigmoid colon is more often affected [5].…”

Section: Discussionmentioning

confidence: 99%

Subcutaneous Facial and Neck Emphysema as First Sign of Intestinal Perforation in a Female Patient After a Routine Colonoscopy

et al. 2017

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Colonoscopy is a safe procedure for the diagnosis and management of colorectal diseases. Colonic perforation due to colonoscopy represents an uncommon complication. Here we present an unusual case of iatrogenic bowel perforation resulting in subcutaneous facial and neck emphysema, pneumomediastinum and pneumoretroperitoneum. Taking a detailed recent medical history information is always required when encountering patients with subcutaneous emphysema after invasive examination procedures. Alertness on iatrogenic complication eventualities may improve prognosis and avoid life-threatening conditions.

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“…This was associated with 13% mor-tality and 53% morbidity [3]. Recently, two extensive reviews of the outcomes following CP by Iqbal [4] and Teoh [5] showed a mortality rate of 7-26% and a morbidity rate of 37-49%, together with a 38% rate of intestinal stoma formation.…”

Section: Introductionmentioning

confidence: 99%

What Are the Risk Factors of Colonoscopic Perforation?

Lohsiriwat¹,

Akaraviputh²,

Lertakyamanee³

et al. 2009

Gastrointestinal Endoscopy

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Outcomes and Predictors of Mortality and Stoma Formation in Surgical Management of Colonoscopic Perforations

Abstract: Colonoscopic perforations were in a decreasing trend. Patients with predictors of mortality should not be treated conservatively. Other options of large bowel investigations should be considered in high-risk patients when the potential diagnostic yield is low.

Cited by 61 publications

References 29 publications

Jatrogeninė kolonoskopinė storosios žarnos perforacija: vieno centro chirurginio gydymo rezultatai

Jatrogeninė kolonoskopinė storosios žarnos perforacija: vieno centro chirurginio gydymo rezultatai

Subcutaneous Facial and Neck Emphysema as First Sign of Intestinal Perforation in a Female Patient After a Routine Colonoscopy

What Are the Risk Factors of Colonoscopic Perforation?

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